19383 POST:THIS CARD NEAR FRONT OF BUILDING` PFxMITNo.
19383
CITY OF CUPERTINO .
INSPECTION DIVISION-'JOB INSPECTION RECORD.'- �J
. JOB ADDRESS 223 �/�1 ICUNIT # .LOT.# -,. CATGQFY CONTROLx
.
OWNER L CONTRACTOR `NQS'-Cp_ v - BUILDING PERMITUMIK FO
•
INSPECTION ' - DATE' INSPECTOR INSPECTION RECORD - El ❑
FOUNDATION/PIERS NOTE ALL GRADING AND DRAINAGE
UFERGROUND SHA LL BE INSTALLED TO COMPLY KITH JOB DESCRIPTION
PAD/SETBACK-CERT •• - TI IE APPROVED PLANS AND CITY OF -
CUPERTINOSTANDARDS. K-" '
GARAGE SLABS PREGUNITE - `,Ta ,
POUR NO CONCRETEUNTILABOVE HAS BEEN''SIGNED
UNDERGROUND/SLAB INSPECTION ' DATE INSPECTOR
PLUMBING -
ELECTRICAL - • '_
MECHANICAL
DO NOT POUR FLOOR'UNTIL ABOVE HAS BEEN SIGNED
WOOD FLOOR -
PLUMBING • -
MECHANICAL '
ELECTRICAL
FRAMING VENTS CLEAR
INSULATION I
PLACE,NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROUGH n..r
PLUMBING - > -
TUBS&SI-TOWER PAN
MECHANICAL
ELECTRICAL/JACUZZI 13OND
FRAMING STAIRS • /f
INSULATION/VENTILATION $ ,
EMERG.EGRESS
;. SEWER WATERCOVER NO WORK UNTIL ABOVES AS.BEEN SIGNED
EXTERIORSFIEAIi BOLD DOWN p
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCKSHEAR v -
i, EXTERIOR LA
TH/W-SCREEN -
S1-IOWEIi LATI-I
SCRATCH COAT
w
. '
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED '
NOTE:NO FINAL INSPECTION SHALL BE MADE BEFORE' .' •THE CONSTRUCTION TAX IS PAID LAO wl �.t
FINALS ' DATE IINSPECTOR
SAN.# / • . .
ELECT.ENERGY
PLUMBING ENERGY ^" ��
MECH.ENERGY
BUILDING ENERGY - - nn' - s'A' f
Il '
ELECT.FINAL TEST � �f�FkXg 6 '
PLUMBING A. �G.-.9 •I _
GAS TEST
" MECHANICAL .. -• - ��' -
'HEATING
ELECTRICAL RELEASE
FIRE DEPT. - - .•. . , LJ/Y
9
CRADE
OCCUPANCY
•' . TEMPORARY APPROVALS
ELECTRIC �� " ' y '• - " _. -
- t
-' •-.,', . . d' .�...`.. .t. .• ,
GAS.
BUILDING
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL - ISSUANCE DATE
�' . 81 HLDINC FINAL IS SIGNED BY BUILDING INSPECTOR - Pima -
ARRANGE FOR INSPECTION I+i
BY 252-1505 BETWEEN /
12:30 PM AND 4:30 PM MONDAY THROUGH FRIDAY 24 HOURS
BEFORE REQUIRED INSPECTION.JOB ADDRESS AND 4 i 4 193J
PERMIT # ARE NEEDED WHEN PHONING.
IMPORTANT!. _RQ
PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION ssuEnov: o
•OFFICE.COPY.
-J
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
-Building roject Identification PERMIT NO.
Ring Addryt.: , 19383
27-549 V M AIL T sdV
t-nvueablrc-v, Je v 0251:—On -72- CITY OF CUPERTINO-BUILDING DIVISION
Contractor's Name: LB �m.No: APPLICATION I PERMIT
BUILDINGCLECIItICA41'LUMB[NGMECIIAMCAI, CATEGORY CONTROLN
• Archllect/Engineer. Ap} 19vt V Lic
s 7FF3
QTY ELECTRIC PERMIT' •FEE BUILDING PERMIT INFO,
- Addr,.4-5F�i,Ma T lots PERMITISSUANC.E El ❑- '
. LICENSEDCONTRACTOR'SDECLARATION
IhereEyafforn that l am licensed under provisions of Chapter9(consume APPLIANCES-RESIDENTIAL . JOB DESCRIPTION
ingwlthS on7000)of Division3ofthe Busineasand ProfesionsCode,and my
license IBI.full f card effect. PANES ,
License Cl Like 4-754FJ� �C1'C�4�.
Dale ll Contractor —[,U ',' A
: -
ARCHITECTS DEC ATION 201-1000 AMPS
µQpW!rewt IuM nd my plans u rds OVERIOODAMPS - .EQ.FT.FLOOR AREA $/SQ.FT.
Licensed Professional .r SIGNS ELECTRICAL � I //7 /o,
ri
Q�7
OWNER-BUILDER DECLARATION SPFCIALCEtCIRT/MISC ,.
t.., Thereby a(@mthatlam exempt fromthe Contractors License Law for the .
LQO^� following reason.(Setion 70313,Business and Prefesslons Cade:Any city or TEMP,METERORPOLEINST.
F F' county which requlrena permit tocovtruct,alter,Improve,demolish,orrepair
anyatmcture prlorm Its Vsuanee,atsoregWrestheapplinnt(or Inch permit to POWER DEVICES
O X U file a signed statement that he is licensed pursuant to the provisions of the
Contractor's Llcevelaw(Chapter9(commencing with Section 7000)o(Divl- SWIMMINGPOOL ELECTRIC - - UA N
O slon3 ofthe na mVAC
Business and ProfesaloCode)orthat he is exempt therefro
and '1/}C1 Q
'u'6 the basis for the alleged exemption. Any violation of Section 7011.5 by any OVTLETSSWITCHFSSEXTUREB
applicant fora permit subjects the applicant to's civil penalty of tat comethen 1
a five hundred dollars($5DO). NEW RESIDENTIAL ELECTR SQ.FT. STORI q
.TYI'G CONSTRUCTION❑I,as owner of the property,or my employees with wages as their sole
C compeneallon,w111dothe work,andthesWcture,is not Intended or offered for
5 O
.Is($ec.7044,Business and Profession Code:The Contractor's Dome Law
don not apply to an owner of property who builds or improves thereon•and OCC.GROUP RIS.UMTS '
E.• who doeasuch work hinestiforthrough hisown employees,provided that such 11
improvements are not Intended oroffered forsale.If,however,thebuilding or TOTAL:
Beproe mentlssold within oneyearofcompletion,the owner-bullderwill have ,.
tf�e�Srden of proving that he did not build or improve for purpose ofsaleJ. Q'•ly; .t',', PLUMBING PERMIT . ,FEE+ FLOOD ZONE APN ,
U 4 as owner of the property,am exclusively contracting with licensed PERMIT ISSUANCE
contractors to construct the project(Sec.7044,Business and ProfessionsCode:
The Contractors Lionow,Law does not apply to an owner of property who �qEg-DRAIN kVENT-WATER(PA)builds or Improves thereon,and who contracts for such pkoj<Rs with a ";\FEE SUMMARY.
�gn((aeo BACK FLOW PROTECT.ctor(s)licensed pursuant to the Contractors Law.w' )
I_f I am exempt under S
B k P C for this reason DEVICE, '}
EELS
. DRAINS FLOOR ROOF,AREA,CONTI. SANITARY - Y N
. Owner Date RFCFlPTN
WORK MAN COMP ETVSATION DECLARATION SCITOOL TAX Y_ N_
❑1 hereby affirm that I have a certificate of consent mself-Insure,ora FIX'NRFS PER TRAP
RECEIPT N
certificate m Workenmloor
'Coperat t Ins. a certified copy thereof(see.
S
3801 Lab CJ CAEA.SYSTEM-1 INCA OUTLETS PARKIN Y_ N_
RECEIPT T a
Po11ry N GAS FA.SYSTEM-OVER 4(EA) BUILDING DIVISION FEE
Com any
r1centBled copy us hereby famished. GREASE/INDUSIRL WASTE INTERCEPTOR PLANCHECKFEE ,
❑j ftcd copy is filed with the city inspection division.
CERTIFICATE OF E(EMPTION FROM WORKERS' GREASE TRAP PAID Na av
COMPENSATION INSURANCE SEWER-SANTTARY-SLORM EA?OOIT Date Remi t#
(This section need not be completed If the permit Is forms hundred dollars
($100)or less) WATER HEATER W/VENT/ELFCTR ENERGYFEE Y_ N—
I certify that in the performance of the work for which this permit Is Issued,
I shall not employ any person in any tanner eo as to be...subject to the WATER SYSTEM/TREATING, PAID
Wmkm
en'Copensatlon taws of California.Date '
OZ Applicant - NEW RMDENTIAL PLMB._SQ%T. Date Remi t#
Z NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you
HO should become subject to the Works.'Compensation provislovof the Labor TOTAL:
W Code,you most forthwith comply with such provisions orthis permit shall be B DING 7- 0
2 j• deemed revoked.
W
CONSTRUCTION LENDING AGENCY
(L Ihembya(Rrmthat there isamvtructlon lendingagency(cribs perform TOTAL: EL CTRIC FEE
D Z ante of the work for which this perret V Issued(Sec.3097,Civ.C.) PLUMBING FEC
0 Lender's Nacre +
LL H Lender's Addmss QTY. MECHANIGAUPERMIT' .'�, E' MECHANICAL FEE
OU 1certlfythatl have readthisappllcatlonand state thatthe above information FEES PAID:
W incorrect.I agree to comply with all city and county ordinances and statelaws PERMIT ISSUANCE
>. V) relating to building covtmction,and hereby authatre repectentatives ofthis
F Z city to enter upon the abovs.mentloned property,for Inspection purposes. ALTERORADDTOMECH.
(We)agree to save,Indemnify an d keep harmleas the City of Cupertino Date Receipt#
V, againstlUt titles,N g AIR HANDLING UNIT 07010,000 GM)
d mento,mete and expenses which may In anyway accrue - SUBTOTAL:
.g.At morn .the granting of this permit. - CONSTRUCTION TAX
AIA HANDLING UNIT(OVER 10,000CFM) '
new re of Applicant/Contractor a EXHAUST HOOD(W/DUCT) CONSTRUCTION TAX PAID:
HAZARDOUS MATERIALS DI SCLOS RE
•
Will the alicanor re building occupant store oreand Is haeanims HEATING UNIT(TO 100,000 BTU)
materia l as defined by
futu
ed by the Cupertino Municipal Code ,Chapter 9.1 2,and the Date ReCei t#
I kelth and Safety Cade Section 25S32(a)7 HEATING UNIT(OVER 1(10,000 BTU) TOTAL:
❑ Yes M No
Will the applicant or fount building occupant useequipment ordevicus VENTILATION FAN(SINGLE REBID) ISSUANCE DATE
which emit havrdous air mots minants as defined by the Bay Area Air p�p
. Qu a lity Management Dktdct2 BOILER-COMPO}IP DR 100,000 BTU) GI'SkB�'
4Yes n No
havercadthehan'�OusmaterialsrequirementsunderChapter6.95of BOILER-COMP(OVER IW,000BN)
the California Health k Safety Code,SectInns 25505,25533 and 25534.1
understand that lithe building does not currently have a tenant,that it u my NEWRESIDENTIAL'MECFL-' SQ.FT.
responsibility to ectify the occupant of the requirements which most be met ,
prior to Issuance of a Certificate of Occupancy.
City Afpq .
Owner or authorised agent Date - - ISSUED BY: .�
TOTAL:
OFFICE COPY